Cardiac extrinsic compression due to abdominal distension as a cause of electrocardiographic abnormality in a critically ill patient

Abstract

Anomalies in the ST segment, especially ST-segment elevation, require the ruling out of possible etiologies such as myocardial ischemia or pericarditis. However, other noncardiac disorders such as increases in intra-abdominal and intrathoracic pressure, may cause ST-segment elevation as well and should be considered as possible etiologies due to the poor prognosis they imply in the clinical evolution of the patient. This is especially important in critically ill patients. In this respect, we herein present a case in which the increase in intra-abdominal pressure and thoracic cavity elevation due to gastric and intestinal distension, which was not present in the first CT, provoked a cardiac and coronary compression resulting in T-shaped dome wave, a QT prolongation and ST segment elevation in the inferior leads of the electrocardiogram, the patient did not present at the time of admission, ruling out other possible etiologies such as ionic imbalance or acute ischemia.

The “Spiked Helmet Sign”, a Mimic of ST-Elevation Myocardial Infarction in Post-Nephrectomy Ileus

“…Although the mechanism of SHS is not well understood, intra-thoracic or intra-abdominal pressure resulting in pulsatile epidermal stretch [1] and marked prolongation of the QT interval [10] are both postulated mechanisms of SHS. In all reported cases, SHS changes on ECG resolve upon treatment of the underlying pathology [2][3][4][5][6][7][8][9].…”

“…SHS is described as a marker of non-cardiac critical disease [1], with intra-abdominal and intra-thoracic pathology with ST changes found in inferior and precordial ECG, respectively [2][3][4][5][6][7][8][9]. This example shows precordial SHS with an intra-abdominal rather than intra-thoracic cause.…”

“…This example shows precordial SHS with an intra-abdominal rather than intra-thoracic cause. Gastric distension, ileus, small bowel obstruction, and bowel perforation are all intra-abdominal pathologies that have been linked to SHS [2][3][4][5][6][7]. Intra-thoracic pathologies associated with SHS include pneumothorax and aortic dissection [7][8][9].…”